Healthcare-Associated Conjunctivitis in the NICU: Microbiological Spectrum, Antimicrobial Resistance and Treatment Patterns

Healthcare-associated bacterial conjunctivitis is an underrecognized yet preventable infection in neonatal intensive care units (NICUs). This study aimed to determine the incidence, risk factors, microbiological profile, and treatment approaches of healthcare-associated bacterial conjunctivitis in neonates. This descriptive, cross-sectional study included neonates diagnosed with bacterial conjunctivitis and followed in the NICU between January 2019 and January 2024. Pathogens were identified by MALDI-TOF MS and antimicrobial susceptibility determined using VITEK 2 according to EUCAST breakpoints. During the five-year period, 104 (2.5%) of 4107 neonates admitted to the NICU developed healthcare-associated bacterial conjunctivitis. Of the pathogens isolated in cultures, 70.2% were Gram-positive bacteria, with coagulase-negative staphylococci being the most common (52.9%), followed by Staphylococcus aureus, Klebsiella pneumoniae, and Serratia marcescens. Empirical treatment consisted of 0.3% topical gentamicin eye drops. In resistant cases, fortified vancomycin drops (32.7%), 0.5% moxifloxacin (4.8%), or 0.3% tobramycin (1.9%) eye drops were administered according to antibiogram results. Compared with Gram-positive infections, Gram-negative conjunctivitis was associated with longer durations of intubation, orogastric feeding, and hospitalization. These findings indicate a predominance of Gram-positive pathogens in NICU-acquired neonatal conjunctivitis, while Gram-negative infections confer greater clinical burden. Fortified antibiotic eye drops are an effective treatment option for resistant cases in high-risk newborns.